Evidence is growing that CBD, and medications that contain combinations of CBD and THC, have some effect on certain forms of pain. In other blog posts we have written extensively on this, making the point that not all pain is the same, and offering what is known about the possible mechanisms of action that could explain these effects.
There is a gap in the research, concerning how these compounds might be used in alleviating pain in older people. Are there age-specific contraindications? Should dosing be altered for this population?
That older people should be a separate category for cannabinoid-based intervention is obvious. As people age theytend to have slower drug absorption, for one thing. This is compounded by the lipophilic properties of CBD edibles, which precipitate in the GI tract, slowing the absorption rate further, and reducing the drug’s bioavailability. CBD being lipid soluble, furthermore, it accumulates in the subcutaneous body fat typical of older adults. This too impedes release and absorption. Age-related changes in body water volume and lean body mass increase the volume of distribution in lipid-soluble drugs, too, prolonging half-life, and possibly amplifying side effect profiles. Low levels of serum albumin can impact protein binding as well, causing higher levels of unbound drug. Metabolism slows with aging, due to reduction in liver size and blood flow, as well. This can also impede breaking down and converting CBD to metabolites, prolonging its clearance. Finally, older adults have slow glomerular filtration rates, which prolongs drug clearance, which itself can result in further side effects or toxicity.
Randomized controlled trials have been conducted on the analgesic properties of CBD in rheumatic pain, cancer pain, fibromyalgia, neurogenic pain from multiple sclerosis, neuropathic pain, and non-specified chronic pain. Results are mixed, some of the time encouraging. But no statistically significant dataset exists on older patients as their own treatment cohort in any of this.
The same is generally true for products containing both THC and CBD. These combined compounds have been shown to be effective in pain from cancer, fibromyalgia, neuropathy, and non-specified chronic pain, though not in rheumatic diseases, nociceptive pain, or peripheral neuropathy. Again, no studies focussed on pain in older adults at all.
Obliquely, there is some utility to be derived from studies evaluating driving while using CBD and combined THC/CBD. There have been differences found in inhaled CBD-dominant, THC-dominant, and THC/CBD equivalent preparations. It has been recommended that older adults, even using CBD-only therapy, especially at high doses, be cautioned about driving or operating heavy machinery.
What is clear, as it were, is that nothing yet is clear. For some very good reasons, older adults should be studied as a pharmacodynamic and pharmacokinetic population of their own – and they have not been. In all of these studies there remains a gap in knowledge of how CBD affects the older adult. All told, fewer than 250 older people have ever been included in any cannabis studies. Care in older adults with chronic pain is complex, and CBD in this population merits its own trials, at the very least to establish safe dosing levels.
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The foregoing is a report on trends and developments in the cannabinoid industry. No product described herein is intended to diagnose, treat, cure or prevent any disease or syndrome.
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